bioneural.net » Informatics

Medical and health app bonanza for iPhone

Bruce — Thu, 31 Jul 2008 07:28:42 +0000

A year ago I bemoaned the lack of third-party native iPhone apps and could suggest few workarounds for absent medical applications. Looking back at The medical Palm (written in 2004) serves to illustrate how stagnant the Palm platform has become—my list of software was essentially unchanged when I retired my Palm from clinical practice earlier in 2008. Although I did experiment with Windows Mobile and tried equivalent medical applications, it wasn't a relationship with a future. Following the lukewarm reception of Web apps Apple's native App Store for iPhone/ iPod touch opened on July 10, and the mobile medical landscape has been transformed in the space of just three weeks. Already we have seen the release of some impressive tools aimed at doctors, medical students, and patients/ well-being enthusiasts. iPhone apps for clinical practice Epocrates Rx (free) is a cross-platform drug formulary featuring monographs, a new visual "Pill ID" tool, an interaction checker (something I found especially useful on home visits using the Palm version), prescribing formularies (downgraded to US-only), and free wireless updates: Which "little white pill" do you mean Mrs Smith? (© Epocrates, Inc.) iChart EMR (£80) is an electronic medical record manager with patient lists, lab reports (manual or automated* retrieval), electronic prescribing*, diagnostic/ procedure codes and billing, and notes (with drawings and graphing of vitals) modules (* requires additional $US100 pa subscription for sync via a web-based application): A clinical information system in your pocket (© Caretools, Inc.) MIM (free) will appeal to referring physicians who can download non-diagnostic radiological images for ...

Clinical knowledge architect for hire

Bruce — Wed, 19 Mar 2008 08:34:04 +0000

From http://www.bioneural.net :

Dr Bruce McKenzie is now available for freelance consultancy as a clinical knowledge architect, addressing the unmet need for usable knowledge resources at the point-of-care in UK general practice. General practitioners (GPs) make more decisions in a day than a typical business executive, and these decisions cost not just money but potentially lives. It's challenging work, and you can but hope your decisions are based on good information. The problem is information overload and access to what you need when you need it: there's just too much and it's too hard to find in the context of a 10 minute consultation. As a GP for 10 years I can relate to this. I also have informatics knowledge and experience, and this puts me in a position to offer you solutions that are built the way a doctor would design them. The fact is information doesn't become knowledge by itself. After careful needs assessment raw information must be broken down and reconstructed into a usable form as part of a design process that draws upon both the art and science of information architecture. In other words it's a creative process, but it also necessitates solid technical insight into the context in which a knowledge resource will be used. With my primary care background, grasp of medical informatics, passion for writing, and practical experience in delivering concise clinical guidance for use at the point-of-care, I am now available for freelance consultancy as a clinical knowledge architect. Experience in primary care Ten years experience in several general ...

Google maps and public health surveillance

Bruce — Sat, 21 Apr 2007 08:08:42 +0000

From http://www.bioneural.net :

Public health doctors are apparently "hopeless" at using traditional media (BMJ 2003;327(7422):1056); it's probable that their use of new media is even worse. WhoIsSick have come up with the idea to use Google Maps to track illnesses in local communities. Perhaps this is something that public health physicians should explore as a means to both inform populations about disease patterns and for encouraging their participation in reporting? There is no need to register with WhoIsSick (as of this writing). To post a sickness anonymously you enter your city (or ZIP code; UK postcodes work too) and detail how many days since the onset of your symptoms; the symptoms you are experiencing; your age; your sex; and additional details (optional): Enter the details of your sickness Make sure to include all your symptoms! Posting this will get you added to the map, with a colour-coded disc to indicate certain common symptoms: Red for "Runny nose" linked to a UK postcode In the search tab you can look for specific symptoms in a specific location within a specific timeframe, narrowed by sex or age: Filter results according to your epidemiological interest In terms of reporting the site offers a number of features: Receive outbreak alerts by e-mail; Percentage breakdown of symptoms (in a pie chart); A graph of no. of cases against timing of sickness (potentially indicating onset of an epidemic or recovery!); A tag cloud for filtering results on a per-symptom basis. Statistics may offer comfort in knowing you're not suffering alone Imagine the consumer power that could be brought to bear if local residents ...

YouTube health videos

Bruce — Wed, 17 Jan 2007 11:48:39 +0000

From http://www.bioneural.net :

As reported by the BBC, a general practice in Wales has begun using YouTube to distribute health information videos. The Builth and Llanwrtyd Medical Practice has thus far uploaded videos relating to inhaler technique and spacer devices in respiratory disease, having a smear, and blood sugar testing in diabetes. It's a novel approach to patient education in a primary care setting, and one that might appeal to that sector of the the population seemingly infatuated with YouTube. Explaining how to use a metered-dose inhaler and spacer without props during a 10 minute consultation is challenging, and video lessons may be a valid alternative to my standard "Ask the pharmacist to demonstrate for you". There's only so much you can convey in printed leaflets, and moving pictures can convey much more detail in a very short time. Inhaler technique (Builth and Llanwrtyd Medical Practice) The practice also offers iPod-friendly QuickTime and Windows Media versions for download.

Medicines information for your iPod

Bruce — Sat, 11 Nov 2006 05:29:24 +0000

From http://www.bioneural.net :

The variety of health-related multimedia available for your iPod (or other MP3 player) and online amusement continues to grow. First we had healthcare podcasts, then health news videocasts from the BBC, followed by 999 (111, 911) advice to store on your iPod. Soon your iPod will help you understand how to take your medicine. medicines.org.uk already makes a selection of patient information leaflets (PILs) available on the web in written form (just in case the dog ate yours). One potential advantage that the site already offers (aside from reading up on what your neighbour is taking) is that you can access large font versions of the leaflets. While this is a potential boon for people with some visual impairment, it doesn't help those who have problems reading or have a severe visual impairment. The next step may seem obvious. Who doesn't have an iPod or similar device these days? While I can't see this appealing to Granny, a select few may enjoy the opportunity to download PILs as MP3s so they can replay the harmful side effects they stand to experience from taking their medicines. I'm sure, however, that terms like "liver damage" and "sudden death" will loose their threatening edge when delivered by means of a reassuring sing-song voice. I know of patients who take maybe 15-20 different medications. If it takes several minutes to record each leaflet, you could fly from Birmingham to Frankfurt with nothing on your playlist but dosage instructions and the like. Great... I'll not be so quick ...

999 advice on your iPod

Bruce — Fri, 21 Apr 2006 03:14:51 +0000

From http://www.bioneural.net :

As reported by the BBC, the Sussex Ambulance Service NHS Trust are providing MP3-based first aid advice on how to deal with common and potentially serious situations (such as fits, collapses and resuscitation). This joins first aid advice available as a podcast on the iTunes Music Store by St. John's Ambulance. The Trust's website provides further details: Did you know you can now download first aid advice in mp3 format to store on your iPod (or any mp3) player? They are copyright free and have been professionally recorded so they will always be crystal clear when ever you need them. They cover all the situations where giving the correct first aid may mean the difference between life and death. All the advice provided is up to date and complies with Resuscitation Council guidelines. Of course, we realise that everyone hopes that they are never confronted with these situations. But unfortunately, the facts are otherwise. What is more, the chances are the victim will be somebody close to you. At first the whole idea seems a bit bizarre. Imagine the scene: there's been a road traffic accident, and several people are injured. In the midst of the chaos stands the wo(man) in charge, identified by the tell-tale white earbuds that scream "I know first aid!". Gesticulating in one direction then the other, shouting instructions to passers-by with eyes and thumbs on the iPod controls to review that last instruction, our luckless hero is unable to hear the approaching ambulance and becomes the incidents only fatality... Worst aid ...

BBC testing health-news video podcasts

Bruce — Tue, 03 Jan 2006 18:48:23 +0000

From http://www.bioneural.net :

A while back I commented on the rise of healthcare-related audio podcasts. I nearly missed the fact that the BBC have, since November 2004, been beta testing BBC News Player feeds. Among the test feeds is one for health stories. This feed contains footage from BBC's TV news reports so differs in content from the existing text-only health-news feed from the news.bbc.co.uk site. As noted here, the feeds do not link directly to the streaming video; this is displayed embedded in a web page to give it proper "context": As is typical on the Internet, a net denizen has created an unofficial feed list that does link directly to the streaming media (Real Player or Windows Media Player required). Ben Metcalfe offers links to broadband streams (also requiring a UK IP address) and narrowband streams so that clicking on an article title will open the appropriate media player rather than a web page with embedded video: The real utility of this service (official or unofficial) is that you can now catch important BBC News items without having to wait up for the next bulletin, or having to visit the main News website to see which health stories have video associated with them. Using Metcalfe's feeds also means you can be listening the audio of one article opened in Real Player (say), while at the same time be reading other posts in your RSS aggregator or newsreader (e.g. Safari). These days anything that helps us multi-task has to be a good thing, right?

Podcasting meets healthcare

Bruce — Wed, 05 Oct 2005 18:30:54 +0000

From http://www.bioneural.net :

Podcasting (from broadcasting + iPod) has become something of a phenomenon. As of today there are 304 podcasts in the "Health" category on the iTunes Music Store and most are free. True, some podcasts may be of dubious value, but there are some by well-regarded institutions. For example, the Mayo Clinic enlightens you on "Understanding infertility", or St. John Ambulance on "How to conduct a primary survey". Medical Edge Radio (Mayo Clinic, USA): a daily 60-second health segment—features general health and people-focused stories covering medical breakthroughs and compelling health information. Mayo Clinic physicians rigorously evaluate all stories for medical validity and newsworthiness. First Aid Advice (St. John Ambulance, UK); St. John Ambulance believes that everyone should learn at least the basic First Aid techniques. You may need to use them at any time at home, at school or work or even while you're travelling. Knowing what to do can make the difference to a person's recovery, and you could even save their life.

QOF checklist and Read Codes

Bruce — Fri, 25 Feb 2005 08:11:20 +0000

From http://www.bioneural.net :

The New General Medical Services Contract (nGMS) for NHS general practitioners changes the way GPs are remunerated. Under the contract GPs are paid performance-related income according to a Quality and Outcomes Framework (QOF)—essentially a list of clinical and other standards associated with points (income) for achieving certain target thresholds. One of the informatics challenges of nGMS is therefore the recording of activity in a consistent and efficient manner. Clinical system templates If a patient has a condition that is singled out by nGMS (e.g. asthma, diabetes, etc.) then the easiest way to record data would be to have the system prompt the GP for anything that is missing (as EMIS does, the system I use at work). There are a few of problems with this approach: The template serves the dual purpose of maximizing QOF points and of managing the patient clinically. You might think there is no conflict here, and although there is some overlap, there is more to managing patients than gathering points. Consequently, the templates can be bloated with requests for data input not required for QOF and it is difficult to see what is "essential" from a points perspective. When time is limited—as it often is—sometimes you might choose to ask the questions or perform the tasks that really "count"; The templates may contain a confusing selection of Read Codes (or Clinical Terms if you prefer). Even before you get into the template you have to code the condition correctly. Because the Read Codes are often not intuitive, consistent, ...

Guidelines: a solution for guideline overload

Bruce — Mon, 21 Jun 2004 11:20:01 +0000

From http://www.bioneural.net :

As previously raised, there are many competing guidelines (NICE, NSF, PCT, etc.) and formularies (Clinical Terms, prescribing) that clinicians must take account of at the point-of-care. Most clinical systems used in British general practice offer templates to prompt data entry and pick-list formularies for prescribing and coding, but these only go so far. How can a practice take account of this competing management advice to streamline and standardize patient care? The answer, somewhat paradoxically, may be to produce another guideline... Why produce an in-house guideline? It promotes a shared standard of care, based on evidence; It can illustrate a role for in-house staff groups (e.g. doctors, nurses, admin) with defined responsibilities; It can converge multiple "competing" guidelines into one ("the best of the best"); It can condense overly complex guidelines for practical use at the point-of-care; It encourages continuity of care (we all follow the same plan); It enables audit against set criteria/ common Clinical Terms; It may improve cost effectiveness (e.g. linkage to a preferred drug formulary, rational lab tests); It should improve clinical outcomes ("best practice"); It could provide documentary evidence for the RCGP QPA; It can help maximise quality point payments under the New GMS Contract; As a guideline cf. protocol, it allows for clinical judgement/ patient preference; It can be useful tool for discussing treatment options with patients. Why use an intranet to publish in-house guidelines? They can be readily updated as the master copy is electronic; This ensures everybody is looking at the same (current) version; The guideline is easily located; It can be cross-linked to other relevant guidelines and documents (e.g. patient ...